Hammer toe implant method

ABSTRACT

An implant is disclosed including an elongate threaded portion and a blade portion extending from the elongate threaded portion. The blade portion has a taper terminating at a point.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/086,136, filed Apr. 13, 2011, which claims priority to U.S.Provisional Patent Application Ser. No. 61/350,665, which was filed onJun. 2, 2010, the entireties of which are herein incorporated byreference.

FIELD OF DISCLOSURE

The disclosed system and method relate implants. More specifically, thedisclosed system and method relate to installing an implant for treatinghammer toe.

BACKGROUND

Hammer toe is a deformity of the toe that affects the alignment of thebones adjacent to the proximal interphalangeal (PIP) joint. Hammer toecan cause pain and can lead to difficulty in walking or wearing shoes. Ahammer toe can often result in an open sore or wound on the foot. Insome instances, surgery may be required to correct the deformity byfusing one or both of the PIP and distal interphalangeal (DIP) joints.

The most common corrective surgery includes the placement of a pin orrod in the distal, middle, and proximal phalanxes of the foot to fusethe PIP and DIP joints. The pin or rod is cut at the tip of the toe,externally of the body. A plastic or polymeric ball is placed over theexposed end of the rod, which remains in the foot of the patient untilthe PIP and/or DIP joints are fused in approximately 6 to 12 weeks. Thisconventional treatment has several drawbacks such as preventing thepatient from wearing closed toe shoes while the rod or pin is in place,and the plastic or polymeric ball may snag a bed sheet or other objectdue to it extending from the tip of the toe resulting in substantialpain for the patient.

Another conventional implant includes a pair of threaded members thatare disposed within adjacent bones of a patient's foot. The implants arethen coupled to one another through male-female connection mechanism,which is difficult to install in situ and has a tendency to separate.

Yet another conventional implant has body including an oval head and apair of feet, which are initially compressed. The implant is formed fromnitinol and is refrigerated until it is ready to be installed. The headand feet of the implant expand due to the rising temperature of theimplant to provide an outward force on the surrounding bone wheninstalled. However, the temperature sensitive material may result in theimplant deploying or expanding prior to being installed, which requiresa new implant to be used.

Accordingly, an improved implant for treating hammer toe is desirable.

SUMMARY

An implant is disclosed including an elongate threaded portion and ablade portion extending from the elongate threaded portion. The bladeportion has a taper terminating at a point.

A method is also disclosed in which an incision is formed to gain accessto a joint between first and second bones. The first and second bonesare flexed such that the bones are disposed at an angle from oneanother. A threaded portion of an implant is advanced into the firstbone. The implant includes a blade portion extending from the elongatethreaded portion. The second bone is repositioned such that a middle ofthe second bone is approximately aligned with the blade portion of theimplant. The second bone is forced into engagement with the bladeportion of the implant.

A surgical assembly is disclosed comprising an implant having anelongate body and a driving assembly. The implant includes a threadedend and a blade end extending from the threaded end. The blade endtapers along its thickness and its width to a point and includes aplurality of serrated edges. The driving assembly includes a handle, adriving rod extending from the handle, and an adapter coupled to an endof the driving rod. The adapter has a body defining a slot at one endthat is sized and configured to receive the blade end of the implant.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the present invention will bemore fully disclosed in, or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which are tobe considered together with the accompanying drawings wherein likenumbers refer to like parts and further wherein:

FIG. 1 is an isometric view of one example of an improved hammer toeimplant;

FIG. 2 is a top side view of the hammer toe implant illustrated in FIG.1;

FIG. 3 is a sectional view of the hammer toe implant taken along line3-3 in FIG. 2;

FIG. 4 is an end on view of the hammer toe implant taken along line 4-4in FIG. 2;

FIG. 5 is a side view of another example of a hammer toe implant;

FIG. 6 is a top side view of the hammer toe implant illustrated in FIG.5;

FIG. 7 is a side view of one example of a driving adapter for use withthe hammer toe implants illustrated in FIGS. 1 and 6;

FIG. 8 is an end view of the driving adapter illustrated in FIG. 7;

FIG. 9 is a side view of another example of a driving adapter for usewith the hammer toe implants illustrated in FIGS. 1 and 6;

FIG. 10 is an end view of the driving adapter illustrated in FIG. 9;

FIG. 11 is an assembly view of a hammer toe implant engaged by a drivingadapter;

FIGS. 12A and 12B illustrate the middle and proximal phalanxes of a footbeing resected;

FIG. 13 illustrates a hammer toe implant being driven into a proximalphalanx;

FIG. 14 illustrates a middle phalanx being drilled or broached;

FIG. 15 illustrates a blade of a hammer toe implant extending from theproximal phalanx with the middle phalanx having been drilled orbroached;

FIG. 16 illustrates a hammer toe implant installed in the middle andproximal phalanxes;

FIG. 17 illustrates another example of a driving assembly for installingan implant;

FIG. 18 illustrates side view of the driving assembly illustrated inFIG. 17;

FIG. 19 is an isometric view of an adapter of the driving assemblyillustrated in FIG. 17;

FIG. 20 is an end view of the adapter illustrated in FIG. 19;

FIG. 21 is a cross-sectional view of the adapter taken along line 21-21in FIG. 20;

FIG. 22 is a cross-sectional view of the adapter taken along line 22-22in FIG. 20;

FIG. 23 is a plan view of the driving rod of the driving assemblyillustrated in FIG. 17;

FIG. 24 is a cross-sectional view of the driving rod taken along line24-24 in FIG. 23;

FIG. 25 is a cross-sectional view of the fin of the driving rod takenalong line 25-25 in FIG. 23;

FIG. 26 is a plan view of driving assembly illustrated in FIG. 17without the o-ring;

FIG. 27 is a cross-sectional view of the handle taken along line 27-27in FIG. 26;

FIGS. 28A and 28B illustrate the middle and proximal phalanxes of a footbeing resected;

FIGS. 29A and 29B illustrate an implant coupled to the adapter of thedriving assembly illustrated in FIG. 17;

FIG. 30 illustrates a hammer toe implant being driven into a proximalphalanx;

FIG. 31 illustrates a middle phalanx being drilled or broached;

FIG. 32 illustrates a blade of a hammer toe implant extending from theproximal phalanx with the middle phalanx having been drilled orbroached; and

FIG. 33 illustrates a hammer toe implant installed in the middle andproximal phalanxes.

DETAILED DESCRIPTION

This description of preferred embodiments is intended to be read inconnection with the accompanying drawings, which are to be consideredpart of the entire written description. The drawing figures are notnecessarily to scale and certain features of the invention may be shownexaggerated in scale or in somewhat schematic form in the interest ofclarity and conciseness. In the description, relative terms such as“horizontal,” “vertical,” “up,” “down,” “top,” and “bottom” as well asderivatives thereof (e.g., “horizontally,” “downwardly,” “upwardly,”etc.) should be construed to refer to the orientation as then describedor as shown in the drawing figure under discussion. These relative termsare for convenience of description and normally are not intended torequire a particular orientation. Terms including “inwardly” versus“outwardly,” “longitudinal” versus “lateral,” and the like are to beinterpreted relative to one another or relative to an axis ofelongation, or an axis or center of rotation, as appropriate. Termsconcerning attachments, coupling, and the like, such as “connected” and“interconnected,” refer to a relationship wherein structures are securedor attached to one another either directly or indirectly throughintervening structures, as well as both movable or rigid attachments orrelationships, unless expressly described otherwise. The term“operatively connected” is such an attachment, coupling or connectionthat allows the pertinent structures to operate as intended by virtue ofthat relationship.

FIG. 1 illustrates one example of an improved implant 100 for treatinghammer toe. As shown in FIG. 1, implant 100 includes a threaded portion102 and a blade portion 104, which are connected together at anengagement portion 106. Implant 100 may have a substantially lineargeometry having an overall length of approximately 19 mm (approximately0.75 inches). In some embodiments, such as the one illustrated in FIGS.5 and 6, blade portion 104 may be disposed at angle with respect to alongitudinal axis defined by the threaded portion 102. The angle may bebetween zero and 45 degrees, and more particularly between approximatelyfive and fifteen degrees, although one skilled in the art willunderstand that implant 100 may have other dimensions and be provided indifferent sizes. For example, implant 100 may be provided in lengths of16 mm and 22 mm, to name a few potential lengths.

Threaded portion 102 may include a plurality of threads 108 disposedalong its entire length, which may be approximately 13 mm (approximately0.5 inches). The tip 110 of threaded portion 102 may be pointed tofacilitate the advancement of threads 108 into bone. Threads 108 mayhave a maximum outer diameter of approximately 2 mm (approximately 0.08inches), although one skilled in the art will understand that threadportion 102 may have other dimensions and be configured to be receivedwithin a phalanx bone of a person. For example, threads may have anouter diameter of approximately 2.4 mm and 1.6 mm, to name a fewpotential possibilities.

As best seen in FIG. 3, blade portion 104 includes a plurality ofserrated edges 112 on its top and bottom sides 114, 116. Blade portion104 may have a width that is greater than its thickness as best seen inFIGS. 2 and 4. For example, blade portion 104 may have a width ofapproximately 0.4 centimeters (approximately 0.16 inches) and athickness of approximately 0.1 centimeters (approximately 0.04 inches)each of which taper to point 118. Blade portion 104 may have asubstantially rectangular cross-sectional area as illustrated in FIG. 4,although one skilled in the art will understand that blade portion 104may have other cross-sectional geometries.

Engagement portion 106 may include a pair of protrusions 120 extendingfrom opposite sides of implant 100 and having rounded outer edges 122.The sides 124 of protrusions 120 may be substantially parallel with eachother as shown in FIG. 4.

Implant 100 is configured to be installed using a driving adapter 200such as the one illustrated in FIGS. 7-10. The driving adapter 200 hasan elongate body 202 having a proximal end 204 and a distal end 206.Body 202 of driving adapter 200 may have a circular cross-sectionalgeometry, although one skilled in the art will understand that body 202may have other cross-sectional geometries including, but not limited to,triangular, rectangular, pentagonal, and hexagonal to name a few.

Proximal end 204 may be substantially solid and have a rounded tip 208.Distal end 206 may define a slot 210 sized and configured to receiveblade portion 104 of implant 100 therein. Slot 210 may have arectangular cross-sectional geometry and have a depth that is sufficientto receive the entire blade portion 104 of implant 100 such that distaledges 212 of slot 210 contact protrusions 120 of engagement portion 106.However, one skilled in the art will understand that slot 210 may haveother cross-sectional geometries and dimensions. Slot 210 may extendthrough side walls 214 of body 202 as shown in FIGS. 7 and 8, or sidewalls 214 may completely enclose slot 210 as shown in FIGS. 9 and 10.

If the driving adapter 200 is to be used with an implant 100 having asubstantially linear lengthwise geometry such as the implant 100illustrated in FIGS. 1-5, then slot 210 may extend in a direction thatis substantially parallel to an axis defined by body 202 of drivingadapter 200. If driving adapter 200 is to be used with an implant 100having a blade portion 104 that extends at an angle with respect to anaxis defined by elongate threaded portion 102 such as the implantillustrated in FIGS. 5 and 6, then slot 210 may extend from distal edges212 at an angle with respect to an axis defined by the length of body202 such that elongate threaded portion 102 of implant 100 is linearlyaligned with body 202 of driving adapter 200 as shown in FIG. 11. Forexample, if blade portion 104 of implant 100 extends at a ten degreeangle with respect to an axis defined by elongate threaded portion 102,then slot 210 of driving adapter 200 may extend at a ten degree anglewith respect to a longitudinal axis defined by body 202 such thatthreaded portion 102 of implant 100 and body 202 of driving adapter 200are substantially linearly aligned.

A method of installing implant 100 in the proximal interphelangeal joint(PIP) 300 is described with reference to FIGS. 12A-16. However, oneskilled in the art will understand that the technique for installing theimplant 100 may be applied to other joints such as, for example, thedistal interphelangeal (DIP) joint between middle phalanx 304 and distalphalanx 306. As shown in FIGS. 12A and 12B, an incision is made to openthe PIP joint 300 and a cutting tool 400 having a blade 402 may be usedto resect adjacent faces of proximal phalanx 302 and middle phalanx 304.The resected surfaces of proximal phalanx 302 and middle phalanx 304 maybe debrided as understood by one skilled in the art.

Blade portion 104 of implant 100 may be disposed within slot 210 ofdriving adapter 200 as shown in FIG. 11, and the body 202 of drivingadapter 200 may be secured in a chuck 412 of a drill 410 or otherdriving instrument as shown in FIG. 13. Drill 410 or other drivinginstrument is used to drive the threaded portion 102 of implant 100 intothe resected surface of proximal phalanx 302. With the threaded portion102 of implant 100 disposed within proximal phalanx 302, driving adapter200 may be disengaged from blade portion 104 of implant 100.

Middle phalanx 304 may be predrilled or broached using drill 410 tocreate a hole 308 as shown in FIGS. 14 and 15. The predrilled orbroached middle phalanx 304 is then repositioned such that thepredrilled hole or broach 308 aligns with the blade portion 104 ofimplant 100. The middle phalanx 304 is then pressed into engagement withthe blade portion 104 as shown in FIG. 16. Serrated edges 112 of bladeportion 104 help to maintain the engagement between middle phalanx 304and blade portion 104 of implant 100.

FIGS. 17-27 illustrate another embodiment of a driver assembly 500 forinstalling an implant into bone. As shown in FIGS. 17 and 18, driverassembly 500 includes an adapter 502 coupled to a driving rod 516 ontowhich a handle 534 is over-molded or otherwise coupled. Adapter 502includes a body 504 with a substantially rectangular side profilecomprising side walls 506-1, 506-2, 506-3, and 506-4 (collectivelyreferred to as “side walls 506”) and a pair of end walls 508-1, 508-2(collectively referred to as “end walls 508”) having a substantiallysquare geometry as best seen in FIGS. 19-22.

Body 504 defines a recess 510 along the length of side walls 506. Recess510 is dimensioned such that an o-ring 544 (FIGS. 17 and 18) may bereceived therein. Additionally, recess 510 is located along side walls506 at a distance from end walls 508 such that recess 510 is alignedwith a valley 126 of serrated edges 112 along the top and bottom sides114, 116 of blade portion 104.

End wall 508-1 defines an aperture 512 having a geometry thatcomplements the cross-sectional geometry of blade portion 104 of implant100. For example, if implant 100 has a straight blade portion 104 asillustrated in FIG. 2, then aperture 512 may extend approximatelyparallel to the lengthwise direction of side walls 506. If the bladeportion 104 of implant 100 is angled as illustrated in FIG. 6, thenaperture 512 may extend from wall 508-1 at an angle relative to theplane defined by side wall 506-2 or 506-4 as will be understood by oneskilled in the art. In some embodiments, aperture 512 has a depth thatis greater than or equal to a length of blade portion 104 such thatblade portion 104 may be received within body 504 and engagement portion106 abuts end wall 508-1. Similarly, end wall 508-2 defines an aperture514 that is sized and configured to receive an end of elongate drivingrod 516 therein.

As best seen in FIGS. 23-25, driving rod 516 includes a fin 518 disposedat a first end 520. Fin 518 disposed at end 20 of driving rod 516 has arectangular shape and is sized and configured to be received withinaperture 512 of adapter 502. Fin 518 defines a slot 522, which is sizedand configured to receive a pin (not shown) for cross-pinning drivingrod 516 to adapter 502. In some embodiments, end 520 may have othercross-sectional geometries including, but not limited to, triangular,square, and pentagonal, to name a few possibilities, that are configuredto be received within aperture 512. Adapter 502 may be over-molded ontothe end of driving rod 516. However, one skilled in the art willunderstand that adapter 502 may be cross-pinned or otherwise coupled todriving rod 516.

The opposite end 524 of driving rod 516 defines a pair of flats 526,528, which are disposed on opposite sides of driving rod 516. As bestseen in FIG. 23, flat 526 extends from tip 530 and is linearly spacedfrom flat 528, which is disposed at a greater distance from tip 530 thanflat 526. However, one skilled in the art will understand that flats526, 528 may be disposed at other positions along driving rod 516. Flats526, 528 are configured to provide a contact surface for coupling tohandle 532, which may be over-molded onto driving rod 516, such thatrotation of handle 532 is translated to driving rod 516.

Turning now to FIGS. 26 and 27, handle 532 has an elongate body 534 thatincludes a plurality of ribs 536 that extend in a longitudinal directionalong body 534 to provide a gripping surface for a user. As best seen inFIGS. 17 and 22, a smooth surface 538 interrupts circumferential ridges540, which are disposed adjacent to proximal end 542 also for providinga gripping surface for a user.

Driver assembly 500 may be provided in a kit with a first adapter 502for use with a straight implant 100 and a second adapter for use with anangled implant 100. A plurality of implants 100 of different sizes mayalso be provided in the kit. The kit may be used in an operation similarto the operation described above with respect to FIGS. 12A-16.

For example and referring to FIGS. 28A-33, an incision is made to openthe PIP joint 300 and a cutting tool 400 having a blade 402 may be usedto resect adjacent faces of proximal phalanx 302 and middle phalanx 304as illustrated in FIGS. 28A and 28B. The resected surfaces of proximalphalanx 302 and middle phalanx 304 may be debrided as understood by oneskilled in the art.

Blade portion 104 of implant 100 is disposed within aperture 512 ofadapter 502 as shown in FIGS. 29A and 29B. With blade portion 104disposed within aperture 512, an o-ring 544 (FIGS. 17 and 18) is placedin recess 510 defined by adapter 502 and within a valley 126 of serratededges 112 along the top and bottom sides 114, 116 of blade portion 104.O-ring 544 secures implant 100 to adapter 502 such that implant does notmove axially out of aperture 512.

Once implant 100 is secured to adapter 502, the surgeon uses handle 534to manually drive threaded portion 102 of implant 100 into the resectedsurface of proximal phalanx 302 as illustrated in FIG. 30. Implant 100is driven into proximal phalanx 302 until engagement portion 106 abutsproximal phalanx 302. Implant 100 is decoupled from adapter 502 byaxially pulling handle 534 away from implant 100 with sufficient forceto flex o-ring 544 and separate adapter 502 from implant 100.

Middle phalanx 304 may be predrilled or broached using drill 410 tocreate a hole 308 as shown in FIGS. 31 and 32. The predrilled orbroached middle phalanx 304 is then repositioned such that thepredrilled hole or broach 308 aligns with the blade portion 104 ofimplant 100. The middle phalanx 304 is then pressed into engagement withthe blade portion 104 as shown in FIG. 33. Serrated edges 112 of bladeportion 104 help to maintain the engagement between middle phalanx 304and blade portion 104 of implant 100.

The implant described above may advantageously be installed through asmall incision as described above. Additionally, the improved implant iscompletely disposed within a toe of a patient, which prevents theimplant from being caught on bed sheets or other objects like theconventional pins.

Although the invention has been described in terms of exemplaryembodiments, it is not limited thereto. Rather, the appended claimsshould be construed broadly, to include other variants and embodimentsof the invention, which may be made by those skilled in the art withoutdeparting from the scope and range of equivalents of the invention.

1. A method, comprising: exposing a joint between first and secondbones; creating a hole in the first bone; advancing a threaded portionof an implant into the second bone, the implant including a bladeportion extending from the threaded portion and having a plurality ofserrations; positioning the first bone such that the hole in the firstbone aligns with the blade portion of the implant; and forcing the firstbone into engagement with the blade portion of the implant.
 2. Themethod of claim 1, further comprising resecting an end of the firstbone.
 3. The method of claim 2, further comprising resecting an end ofthe second bone.
 4. The method of claim 1, further comprising resectingan end of the second bone.
 5. The method of claim 1, further comprising:placing a driving adapter over the blade portion of the implant, whereinadvancing the threaded portion of the implant includes using a drivingtool coupled to the driving adapter to advance the threaded portion ofthe implant into the second bone.
 6. The method of claim 1, wherein thejoint is a proximal interphelangeal joint.
 7. The method of claim 6,wherein exposing the joint includes forming an incision over theproximal interphelangeal joint.
 8. The method of claim 1, wherein thefirst bone is a middle phalanx, and the second bone is a proximalphalanx.
 9. An method, comprising: exposing a proximal interphelangealjoint; resecting an end of a proximal phalanx; resecting an end of amiddle phalanx such that the adjacent faces of the proximal and middlephalanxes are resected; creating a hole in the resected end of themiddle phalanx; inserting a threaded portion of a hammer toe implantinto the resected end of the proximal phalanx, the hammer toe implantincluding a blade portion extending from the threaded portion and havinga plurality of serrations; positioning the middle phalanx such that thehole in the middle phalanx aligns with the blade portion of the hammertoe implant; and forcing the middle phalanx into engagement with theblade portion of the hammer toe implant.
 10. The method of claim 9,further comprising placing a driving adapter over the blade portion ofthe hammer toe implant, wherein inserting the threaded portion of thehammer toe implant includes using a driving tool coupled to the drivingadapter to advance the threaded portion of the hammer toe implant intothe proximal phalanx.
 11. The method of claim 9, wherein exposing theproximal interphelangeal joint includes making an incision over theproximal interphelangeal joint.
 12. The method of claim 10, wherein theblade portion of the hammer toe implant extends from the threadedportion of the hammer toe implant at angle with respect to an axisdefined by the threaded portion of the hammer toe implant.
 13. Themethod of claim 12, wherein the angle is between zero and 45 degrees.14. The method of claim 12, wherein the angle is between five and 15degrees.
 15. The method of claim 12, wherein a thickness dimension ofthe blade portion of the hammer toe implant is less than a widthdimension of the blade portion of the implant.
 16. The method of claim12, wherein a diameter of the threaded portion of the hammer toe implantis between 1.6 mm and 2.4 mm.
 17. The method of claim 12, wherein adiameter of the threaded portion of the hammer toe implant is 2 mm. 18.The method of claim 12, wherein creating the hole in the resected end ofthe middle phalanx includes using a drill or a broach.
 19. A method,comprising: making an incision over a proximal interphelangeal joint;exposing the proximal interphelangeal joint; resecting an end of aproximal phalanx; resecting an end of a middle phalanx such thatadjacent faces of the proximal and middle phalanxes are resected;creating a hole using a drill or a broach in the end of the middlephalanx that was resected; inserting a threaded portion of an implantinto the end of the proximal phalanx that was resected, the implantincluding a blade portion extending from the threaded portion and havinga plurality of serrations; positioning the middle phalanx such that thehole in the middle phalanx aligns with the blade portion of the implant;and forcing the middle phalanx into engagement with the blade portion ofthe implant.
 20. The method of claim 19, further comprising placing adriving adapter over the blade portion of the implant, wherein insertingthe threaded portion of the implant includes using a driving toolcoupled to the driving adapter to advance the threaded portion of theimplant into the proximal phalanx.